title: Colonoscopy following nonoperative management of uncomplicated diverticulitis may not be warranted.
abstract: BACKGROUND
  Following the nonoperative management of acute diverticulitis, guidelines recommend routine follow-up colonoscopy; however, evidence to support this recommendation are lacking.
  
  
  OBJECTIVE
  This study aims to determine the diagnostic yield of endoscopy for clinically significant neoplasia following the successful nonoperative management of acute diverticulitis.
  
  
  METHODS
  This study is a retrospective review.
  
  
  METHODS
  This study was conducted in a large urban health region.
  
  
  METHODS
  Adult patients who were admitted with a diagnosis of acute diverticulitis confirmed by CT and who were successfully managed nonoperatively to hospital discharge were included. Patients who underwent colonoscopy within 2 years of presentation were excluded.
  
  
  METHODS
  The primary outcome measured was the incidence of clinically significant neoplasia (invasive malignancy or advanced adenoma) on follow-up endoscopy within 1 year of admission.
  
  
  RESULTS
  Four hundred fifty-eight patients were selected for analysis, of which 249 patients (54%) underwent endoscopy within 1 year of admission. Seventy-seven (30.9%) patients were found to have polyps, 19 (7.6%) patients had advanced adenomas, and 4 (1.6%) patients had an invasive malignancy; 23 patients (9.2%) were found to have clinically significant neoplasia. On subgroup analysis, patients presenting with complicated diverticulitis (n = 74) had a significantly higher incidence of advanced adenoma (18.9% vs 5%, p = 0.001) and invasive malignancy (5.4% vs 0%, p = 0.007) in comparison with patients who presented with uncomplicated diverticulitis (n = 175). On multivariate analysis, patient age (OR 1.04 (1.01-1.08), p = 0.02) and the presence of abscess (OR 4.15 (1.68-10.3), p = 0.002) were identified as significant risk factors for clinically significant neoplasia.
  
  
  CONCLUSIONS
  The use of retrospective data was a limitation of this study; 54% of selected patients underwent endoscopic follow-up.
  
  
  CONCLUSIONS
  The incidence of clinically significant neoplasia on endoscopic follow-up after the nonoperative management of acute diverticulitis is 9.2%. Those with complicated diverticulitis are at higher risk, whereas the incidence of clinically significant neoplasia in those with uncomplicated diverticulitis is equal to the incidence in average-risk individuals. Routine diagnostic colonoscopy following the nonoperative management of acute uncomplicated diverticulitis may not be warranted.
authors.affiliation: 1 Department of Surgery, University of Calgary, Calgary, Alberta, Canada 2 Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada.
authors.forename: Mantaj S
authors.initials: MS
authors.lastname: Brar
authors.forename: George
authors.initials: G
authors.lastname: Roxin
authors.forename: Paul B
authors.initials: PB
authors.lastname: Yaffe
authors.forename: Jennifer
authors.initials: J
authors.lastname: Stanger
authors.forename: Anthony R
authors.initials: AR
authors.lastname: MacLean
authors.forename: W Donald
authors.initials: WD
authors.lastname: Buie
mesh_terms: D000038:Abscess / Q000453:epidemiology; D000208:Acute Disease; D000236:Adenoma / Q000175:diagnosis; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003110:Colonic Neoplasms / Q000175:diagnosis; D003111:Colonic Polyps / Q000175:diagnosis; D003113:Colonoscopy; D004239:Diverticulitis, Colonic / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012004:Rectal Neoplasms / Q000175:diagnosis; D012189:Retrospective Studies; D012307:Risk Factors